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Table 2 Subthemes mapped to the components and sub-components of the COM-B model

From: Therapists’ perspectives on using brain-computer interface-triggered functional electrical stimulation therapy for individuals living with upper extremity paralysis: a qualitative case series study

 

COM-B subcomponents

Inductive subthemes

Quote number

Quote

Capability

Physical

Transfer of physical ability and modality use

1

“I didn’t feel like I needed more skills in using the FES unit because it was pretty straight (forward), the FES unit.” (P6)

2

“[Would you need to increase your physical strength or endurance?] "Not really I go to the gym.” (P5)

3

“I wouldn’t say I have to increase my strength or even facilitation. I always get the patient into a more biomechanically advantageous position for me to do these treatments.” (P1)

Psychological

Applying varying depths of evidence-based research to BCI-FEST

4

“I did not receive any formal training. But, of course, informal training in the sense of how the BCI works, what potentially are the benefits of using BCI-FES or only using FES.” (P3)

5

“I brag about delivering an evidence-based intervention. So, I really am patient centred. But [patients] ask me: “Is this going to improve? How is my movement? Is this voluntary or a reflex? Is it spasticity or hypertonia?”…Your comments, your information, that you are disseminating to your patient, their family, or your other team members in rounds must be very accurate. Will you rely on science rather than: “Oh I think? Oh, maybe?” [Science] is more accurate. Consistent. So, then we can use an outcome measure.” (P5)

Reliance on the supplementary knowledge of the BCI operator

6

“I would feel more comfortable to know that I have resources and other people to talk to if I have trouble using it or if I have a difficult case. Also, with the [BCI operator] understanding the device better in a technical way, that would be great too.” (P4)

7

“And some patients, they were frustrated because, I think, lots of therapists and engineering…I prefer the therapist to know everything and have one less person in the scene. Less interruption because we want to satisfy the patient and get the most of it.” (P5)

Opportunity

Physical

Set-up time relative to therapy time required for BCI-FEST

8

"To be honest, I think lots of patients would benefit from (BCI-FEST) so just the barriers of setup time, having an extra person there, and whether and how effective the therapy is. (This is) what will take me one way or the other in terms of whether I choose to use the unit or not.” (P1)

9

“I think when you are doing the therapy, you always wonder whether it was enough time; but I think when you look back on it you realize it’s tiring for the patient. If they’re really focusing, doing a good job, and putting all their mental attention to it, you probably don’t want to do it too long. Probably half an hour is a good amount of time for them to fully concentrate and focus.” (P2)

10

“Maybe it was the study, the push, you know, rush rush RUSH. We have one hour. The patient, might have a catheter, have to, empty their bladder, then they come back. It was a rush. So, when we have someone, in this one-hour window, it didn’t allow me to treat the way I treat my patients (P5)

Extra resources are needed to increase the efficiency and clinical feasibility of BCI-FEST

11

“In a clinical sense, outside of a study, it would be resource intensive because it requires the computer and the head setup and the FES unit, and then two people, both the engineer and the therapist, to be available at the same time, right?” (P6)

Social

BCI-FEST therapist community development

12

If there were a group of therapists that all utilize “BCI FEST. If you could converse with them about it…It’s a new device, it’s research and I’m pretty sure at the beginning, not everyone will be using it. It (could be used) to share experiences, the good and the bad.”

“I think the idea of having a group is very good and frequent communication with the group for example. So, just reach out to them: Are you using the BCI-FES?” “Do you have any questions? Do you need a call?” Just a reminder because things like that go on a shelf very easily and they stay there.” (P4)

Motivation

Automatic

Passion for technology promotes the intuitive use of BCI-FEST

13

"Oh yeah. I think that any new technology, I think that you have to get into it and practice so that it will become second nature.” (P3)

Reflective

Knowledge from scholarly practice and inquiry innately transfers to BCI-FEST

14

“In general, I look at the patient and see where they’re at and what their goals are. Then I try to think of different technology, different treatment styles that would help them reach their goals. If BCI-FES is one of them, it’s something that I would bring up to them and see what their thoughts are.” (P1)

15

“So doing (UE training) 1 h, 5 times per week, we are not training the rest of what (the patient) needs to work on. Maybe in the chronic stages when they want to work mostly on the hands and upper extremity function, that will be good. But in acute and subacute rehab, this is absolutely not something that I will do because it won’t do the rest (of the body) and the rest is very important.” (P4)

16

“I think this system is going to help me to evaluate my interventions, whether they are working or not working.” (P5)